<form class="form" method="post">
    <table>
        <tr class="new_input">
            <td><label for="server">MySQL Host: </label></td>
                <td><input type="text" name="server" id="server_input" onkeyup="ValidateForm();" onblur="ValidateForm();" /></td>
                <td><img src="../images/incorrect.png" alt="Incorrect" id="server_img"/></td>
        </tr>

        <tr class="new_input">
            <td><label for="database">Database Name: </label></td>
                <td><input type="text" name="database" id="database_input" onkeyup="ValidateForm();" onblur="ValidateForm();" /></td>
                <td><img src="../images/incorrect.png" alt="Incorrect" id="database_img"/></td>

        <tr class="new_input">
            <td><label for="username">Username: </label></td>
                <td><input type="text" name="username" id="username_input" onkeyup="ValidateForm();" onblur="ValidateForm();" /></td>
                <td><img src="../images/incorrect.png" alt="Incorrect" id="username_img"/></td>
        </tr>

        <tr class="new_input">
            <td><label for="password">Password: </label></td>
                <td><input type="password" name="password" id="password_input" onkeyup="ValidateForm();" onblur="ValidateForm();" /></td>
                <td><img src="../images/incorrect.png" alt="Incorrect" id="password_img"/></td>
        </tr>

        <tr class="new_input">
            <td><label for="port">Port: </label></td>
                <td><input type="text" name="port" value="3306" id="port_input" onkeyup="ValidateForm();" onblur="ValidateForm();" /></td>
                <td><img src="../images/correct.png" alt="Correct" id="port_img"/></td>
        </tr>
        <tr>
            <td colspan="3">
                <input type="submit" name="fSubmit" value="Test Connection" onclick="if ( ValidateForm() ) return true; alert('One or more of your values is incorrect'); return false;" />
            </td>
        </tr>
    </table>
</form>